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Intramyometrial Oxytocin in Preventing Postpartum Hemorrhage during Cesarean Delivery: A Systematic Review

Joanna Marie O. Guerra-Calilung, MD; Florante P. Gonzaga, MD, FACOG, FPOGS, FACS
Department of Obstetrics and Gynecology, The Medical City

Background: Postpartum hemorrhage from uterine atony, a major global and local health burden, remains to be a leading cause of maternal mortality. Intravenous oxytocin infusion has become the conventional first-line drug in the active management of third stage of labor in most countries. This, however, has been associated with refractory uterine atony and major hemodynamic side effects; hence the need to explore on the possibility of a better alternative such as intramyometrial oxytocin administration.

Objective: The study aims to evaluate the efficacy and safety of intramyometrial oxytocin in preventing postpartum hemorrhage during cesarean deliveries.

Methods: A review was done involving electronic search of databases for randomized clinical trials published since 1980, and a check of all the references according to inclusion and exclusion criteria. Four full articles were retrieved and assessed for methodological quality. Data were extracted and analyzed.

Results: Comparisons involved (1) intramyometrial versus intravenous oxytocin, and (2) intramyometrial oxytocin against intramyometrial carboprost. Limited evidence showed significant reduction of postpartum hemorrhage (RR 0.40; 95% CI 0.19 to 0.82) and maternal adverse drug events (RR 0.10; 95% CI 0.01 to 0.75) with intramyometrial oxytocin compared to intravenous oxytocin. Maternal adverse events were reduced, but not significantly, in intramyometrial oxytocin compared with intramyometrial carboprost.

Conclusion: Guideline changes could not be recommended because there is insufficient information about intramyometrial oxytocin administration from the small number of studies and participants available.